This is not the most recent version of the article. View current version (7 SEP 2011)

Intervention Review

Oral contraceptives for functional ovarian cysts

  1. David A Grimes1,*,
  2. LaShawn B. Jones2,
  3. Laureen M Lopez1,
  4. Kenneth F Schulz3

Editorial Group: Cochrane Fertility Regulation Group

Published Online: 15 APR 2009

Assessed as up-to-date: 11 DEC 2008

DOI: 10.1002/14651858.CD006134.pub3

Database Title

Additional Information

How to Cite

Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD006134. DOI: 10.1002/14651858.CD006134.pub3.

Author Information

  1. 1

    Family Health International, Behavioral and Biomedical Research, Research Triangle Park, North Carolina, USA

  2. 2

    Family Health International, Science Facilitation Department, Research Triangle Park, North Carolina, USA

  3. 3

    Family Health International, Quantitative Sciences, Research Triangle Park, North Carolina, USA

*David A Grimes, Behavioral and Biomedical Research, Family Health International, PO Box 13950, Research Triangle Park, North Carolina, NC 27709, USA. dgrimes@fhi.org.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 15 APR 2009

SEARCH

ARTICLE TOOLS

This is not the most recent version of the article.View current version (07 Sep 2011)

View Full Article (HTML) Summary (58K)Standard (229K)Full (275K)
 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Functional ovarian cysts are a common gynecological problem among women of reproductive age worldwide. When large, persistent, or painful, these cysts may require operations, sometimes resulting in removal of the ovary. Since early oral contraceptives were associated with a reduced incidence of functional ovarian cysts, many clinicians inferred that birth control pills could be used to treat cysts as well. This became a common clinical practice in the early 1970s.

Objectives

This review examined all randomized controlled trials that studied oral contraceptives as therapy for functional ovarian cysts.

Search strategy

We searched the databases of CENTRAL, MEDLINE, POPLINE, and EMBASE, as well as clinical trials databases (ClinicalTrials.gov and ICTRP). We also examined the reference lists of articles and wrote to authors of identified trials to seek articles we had missed.

Selection criteria

We included randomized controlled trials in any language that included oral contraceptives used for treatment and not prevention of functional ovarian cysts. Criteria for diagnosis of cysts were those used by authors of trials.

Data collection and analysis

Two authors independently abstracted data from the articles. One entered the data into RevMan and a second verified accuracy of data entry. For dichotomous outcomes, we used Peto odds ratios with 95% confidence intervals (CI). For continuous outcomes, we calculated mean differences with 95% CI.

Main results

We identified seven randomized controlled trials from four countries; the studies included a total of 500 women. Treatment with combined oral contraceptives did not hasten resolution of functional ovarian cysts in any trial. This held true for cysts that occurred spontaneously as well as those that developed after ovulation induction. Most cysts resolved without treatment within a few cycles; persistent cysts tended to be pathological (e.g., endometrioma or para-ovarian cyst) and not physiological.

Authors' conclusions

Although widely used for treating functional ovarian cysts, combined oral contraceptives appear to be of no benefit. Watchful waiting for two or three cycles is appropriate. Should cysts persist, surgical management is often indicated.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Oral contraceptives to treat cysts of the ovary

Women of reproductive age usually release an egg about once a month. The ovary gets an egg from the inside of the ovary to its surface by creating a blister or fluid-filled space around the developing egg. When the blister (or cyst) reaches the surface of the ovary, it bursts and releases the egg into the abdominal cavity. After this occurs, the blister can develop into another type of cyst, which makes a hormone (progesterone) that helps the pregnancy to grow. Most of these cysts come and go without problems. Sometimes, however, the cysts get large or painful; others may remain for months. Several decades ago, health care providers learned that women taking birth control pills had fewer cysts, since the pills usually kept an egg from being released. Based on this fact, many clinicians started treating these cysts with birth control pills to make them go away faster.

We did a computer search for all randomized controlled trials that studied use of birth control pills to treat these benign (also called functional) cysts. We wrote to researchers to find other trials. We found seven trials from four countries; they included 500 women. Two trials included women receiving drugs to help them get pregnant. The other five included women who developed cysts without fertility treatment. In none of these trials did oral contraceptives help the cysts go away faster. Thus, birth control pills should not be used for this purpose. A better approach is waiting two or three months for the cysts to go away on their own.

View Full Article (HTML) Summary (58K)Standard (229K)Full (275K)